© UNICEF Mozambique/2008/Machiana

Health worker Cândida Chaves vaccinates children against tetanus at Bango Primary School, in the Xai-Xai district of Gaza Province. She is part of the ‘Reach Every District’ mobile health unit that visits remote communities.


In the early hours of the morning at Chicumbane Rural Hospital, health worker Cândida Chaves is already at work, preparing for a long day on the road. Today, she will oversee the activities of a mobile health team travelling to Bango, a remote community of about 3,900 people in Gaza Province. As the last boxes of vaccines are loaded onto the vehicle, Ms. Chaves and two nurses give a final check to make sure that nothing has been left out before they take the road.

The vehicle is packed with vaccines, scales to weigh children, medicines to treat the most common childhood illnesses, instruments for observing pregnant women, and pills for family planning and for treating sexually transmitted diseases. “Everything that is needed to provide basic community health services,” says Ms. Chaves, as she jumps into the vehicle. The half-hour journey along a tarred road – which soon turns into sandy tracks – takes them through fields where people are working the land, herding cattle, and selling produce. “Twice a week we visit a different community, and we try to revisit the same community at least once a month for vaccinations,” explains Ms. Chaves, who is in charge of epidemiological surveillance in the district.
When the team arrives in Bango, a crowd of women with their children are patiently waiting in front of the school in spite of the rain that has begun to fall. The previous day, the school’s director had mobilized his students to alert the women and mothers of the community to bring their smaller children. In the queue is Ana Paula, a young mother who has brought her 22-month-old daughter Madalena to be weighed and examined.

“My daughter Madalena has diarrhoea, and her body’s been very hot since last week. I’ve brought her because her medication has finished and she’s still ill,” says Ana Paula. Like many other children living in rural areas, little Madalena is up against great odds to survive. Out of around 855,000 infants born every year in Mozambique, about 143,640 die before they reach their fifth birthday. The main killers of children are malaria, diarrhoea, acute respiratory infections and vaccine-preventable diseases.

Over the past 20 years, impressive progress has been made in improving the survival and health of Mozambican children. However, gains in child and maternal well-being have not been even across the country and large numbers of children and women, especially those living in remote areas, are not being reached. In addition, many children die at home because their parents ignore how to prevent diseases, or have no easy access to health facilities. This is why mobile health units play a crucial role in bringing health services to remote communities. These services are clearly making a difference for mothers and their children.

“I like the work of the health brigade because they come close to my home. I would find it difficult to take my child to the health centre. When I’ve finished with Madalena here, I’ll go home to bring my other child, who’s four years old,” says Ana Paula, as she prepares Madalena to be weighed by the nurse.

The health brigades and mobile units are part of the Reach Every District (RED) approach that brings vaccination services to remote communities combining them with other health interventions, such as nutrition, malaria control and maternal health. The RED approach is part of a broader accelerated child survival and development strategy implemented by the Ministry of Health, with the support of UNICEF and other partners, to scale up high-impact child survival interventions aiming at reaching every newborn and child in every district with a few priority interventions.

It’s already late in the afternoon in Bango when the last child is vaccinated by the health team. The sun is now poking through the clouds and, after making sure that no child is left behind, the team packs their equipment before heading back to the hospital.